Diabetes Burnout: When To Leave "Good Enough" Alone

Sisyphus by George Bybee / bybee.temp.evolutionstudio.com

| Apr 14, 2007

There's an ancient Greek myth about a man named Sisyphus who was cursed to roll the same rock up a hill, then see it roll down, then roll it up again, for eternity.  There's something a bit like diabetes self-care in that myth.

The Burden of Management

Diabetes is more than a chronic disease. It offers hope, because what you do makes a difference. But that responsibility, while an opportunity, is a heavy burden. Because diabetes must be actively "managed," it's like a to-do list that rewrites itself every day. There is never a gold star for good performance, never an "okay, that's that," where you can dust off your hands and turn away from a task well done.  The task is never done, and often it seems that no matter how hard you try, the task is never done well.

Ground down by the appalling endlessness of self care, people with diabetes sometimes turn their faces away in denial and stop taking care of themselves, becoming what used to be called "non-compliant." Other people give up on self-care out of rebellious fury at the unfairness of having diabetes. But giving up on your own care is the worst thing you can do for your health, both physical and emotional. So don't let yourself sink below the surface:  there are ways to keep your head above water.

Don't Panic

Most important, don't panic. James Hirsch, author of Cheating Destiny, points out that diabetes has ups and downs, and they're not your fault. When you have a good day, take credit.  When you have a bad day, blame the disease. Be realistic, not perfectionistic.

Panic and guilt stem from feeling that because your care isn't perfect, you're doomed to complications.  But you must keep in mind that occasional highs don't cause complications.  Complications are the result of years of unchecked hyperglycemia. Blood glucose sometimes has a mind of its own, and it will vary no matter how hard you try. If you feel crushed or angry when you get a high result on your blood glucose meter, you're not going to keep setting yourself up by checking frequently.  Getting "bad news" from the meter, if you take it as a failure, can lead to panic and a sense of futility. And that can cause paralysis and the downward spiral of apathy.

Dr. Susan Guzman of the Behavioral Diabetes Institute believes that your goal should be "good enough." It's perfectionism that is lethal, because it leads to inevitable defeat and abandonment of effort. "Good enough" is the goal.  That doesn't mean that you're lax: it just means that your goal is what's attainable, not what's out of reach. It means balancing the benefits of good control with the demands of real life.

Someone Who Understands

If you're feeling guilty and panicky, the stress can lead to depression, which is twice as common in people with diabetes as in people in general. Contributing to untreated depression is the culture of diabetes, which adamantly forbids anything that might be interpreted as whining. In fact, you're required to frequently assert that you could be much worse off and that diabetes is certainly not as bad as many other diseases.

If you're depressed, you may feel guilty and a failure for not being able to manage that  seemingly mandatory glass half-full attitude. In fact, however, diabetes is a very difficult disease just because the relaxation of passivity is forbidden. And depression commonly accompanies diabetes.  So if you do become depressed, realize that you are not alone.  Furthermore, nowadays, there is help for you.  Make the effort to seek out professional assistance for counseling and medication. It will help you.

Everybody needs support, someone who understands how hard diabetes is and who empathizes with the constancy of your effort.  That's what you need from your friends and family. If they act more like "the diabetes police," by constantly correcting or checking on you, talk to them about changing their tune to something more supportive.  Diabetes policing just makes you want to conceal your behavior from others as if you are a guilty criminal. A diabetes support group, even if it's on-line, can also be a real help in finding people who truly understand what's going on with you.

Change Your Behavior

Try not to be knocked down by individual meter readings. Instead, use your A1c percentage as a better measure of how you're doing in managing your diabetes.  It doesn't help to tell yourself, "I should be doing everything better."  Set small specific, and achievable goals that you can meet. If you've fallen into despair, take baby-steps to get out of your hole. If your diabetes schedule or diet is too restrictive, making you feel that your life is nothing but grind, talk with your doctor about ways to loosen up your self-care a bit so that life is still enjoyable.

There are lots of sources of help these days.  On-line communities can be a way to connect with others who understand you.  The Behavioral Diabetes Institute, founded by Dr. William Polonsky, who authored Diabetes Burn-Out: What To Do When You Can't Take It Anymore, is another resource. He and his staff will answer questions on-line about how you're doing if you can't make it to San Diego to visit them.

Above all, don't lose heart.  Life isn't perfect, and you can only do as well as you can do.  Give it your best shot, and seek help when you need it.  "Good enough" will keep you healthy.

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Categories: A1c Test, Blood Glucose, Burnout, Depression, Diabetes, Diabetes, Exercise, Type 1 Issues

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Posted by jolo on 19 December 2007

I cannot thank you enough for this article.
It is so important that we understand that the social/psychological element, the depression, the anxiety is NOT OUR FAULT. YES, it is our responsibility to work with what we have, but the blame part is horrific. I wish all doctors would understand this.
I personally have been diagnosed with Diabetes in the past two years. Since then, my wife of 16 years, who never wanted to understand, has left me and cut off my medical insurance so she can use the money for her living expenses. Not easy to take care of myself and deal with this enormous stress.

Thanks so much for re-enforcing the fact that "we are not alone".


Posted by volleyball on 20 December 2007

This article will give lots of people the needed permission to help manage their diabetes. Some people who are overly competitive won't get that good numbers may be better than great numbers.
I did have some issues with the logic of the article, it does convey that management is the overall picture, not a single event is what determines health. While any very low or very high must be addressed immediately, a "bad" reading may be just something that happened and not to worry about.

Posted by Ladybird on 22 January 2008

The best thing about this article is to know that we are not alone; there are many of us who often wonder how long is looking at the meter going to continue. Yes, for a while some of us do get tired of the whole spiel, but know if we want to live as healthily as possible, we have to do it, there is no alternative.

Thank you for writing this, that's it OK, to feel a bit depressed sometimes, but we need to move on.

I think one of the ways that could help us is to keep busy with things all the time as we keep a tab on our glucose levels.

Posted by Anonymous on 17 August 2008

This article is very encouraging to a Type 1 diabetic. I have had Type 1 for about 14 years and have had my share of accompanied depression. For a few years in college I went non-compliant because I could not take it anymore. In the last year I realized that if I want to have a better future then I would have to change my life and take care of myself because diabetes is an all-encompassing disease. It takes on many areas of the human body. I quit drinking, I ended a 2 year relationship with an alcoholic, eat healthy, run a few miles few times a week and write down as much as I can before I want to scream. There are times when I get lonely or bored on a Friday night, as it is summer in a college town, but overall I am happier then hell.

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